Cervical Spinal Stenosis: Patient Treatment Guide

Cervical spinal stenosis (CSS) is when the spinal canal of the neck becomes narrow and starts to press on the spinal cord. "Stenosis" means a narrowing of a body area. Spinal stenosis can also affect the lumbar spine (low back).

Stenosis of the neck is often caused by aging and disc herniation. Symptoms may include pain, numbness, weakness, and problems with balance or coordination. While the condition can be challenging to diagnose, it is treatable and manageable through various options.

This article will cover causes, risk factors, symptoms, how the condition progresses, secondary effects, treatment options, and more.

CSS has many causes, including spinal changes and injuries that cause the spinal canal to narrow. These causes fall into two categories—congenital (present at birth) and acquired (developing after birth, usually later in life).

Congenital CSS is extremely rare. If someone has it, they were born with a narrow spinal canal. It generally does not produce symptoms until adulthood, so most parents do not know their child has the condition.

Congenital CSS cannot be prevented or detected before birth and seems more common in people with achondroplasia dwarfism. When occurring with achondroplasia dwarfism, it may either be benign and not produce symptoms or begin to show symptoms later in adulthood.

Acquired CSS is much more common and results from wear and tear changes with age. Epidemiological data suggest acquired CSS affects 1 in 100,000 people.

Additional causes of acquired CSS are:

Your risk of developing CSS increases with age. Most people with the condition are over 50. Younger people with cervical scoliosis (curvature of the cervical spine) and other cervical spine disorders are also at risk for cervical spine narrowing.

It is possible to have CSS and not experience any symptoms. In this case, it is considered asymptomatic (no symptoms). Even so, there is still a narrowing in the spinal canal of the cervical spine. Asymptomatic CSS does not cause symptoms despite spinal canal narrowing.

Asymptomatic CSS is often found during imaging done for another purpose. While treatment may not be immediately necessary, regular monitoring and follow-up with a healthcare provider can address symptoms if they develop.

If your healthcare provider says your CSS is progressive, the spinal canal has narrowed with time. If the condition keeps progressing, it might lead to spinal cord or nerve compression. The narrowing will worsen without treatment, and you will experience more severe symptoms.

Symptoms of progressive CSS might include:

Various factors can aggravate CSS progression. This includes injuries to the intervertebral discs, which can accelerate degeneration (bone aging) processes.

A healthcare provider, chiropractor, or physical therapist might suspect a diagnosis of CSS based on the symptoms. They will then want to collect additional information from you and perform testing. They may refer you to the appropriate healthcare provider for a diagnosis.

Information and testing to confirm a diagnosis might include:

CSS is generally not life-threatening but can be extremely serious and lead to long-term problems. Without treatment, symptoms worsen, making it hard for you to do normal daily activities and affecting your ability to get a good night's sleep.

If CSS affects other areas of the spine, it can impact your gait or ability to carry and lift. It may also cause nerve cells to become damaged, including the nerves that control urination and bowel movements. In rare cases, it can lead to paralysis of one or both arms and legs.

CSS can also progress to cervical spondylotic myelopathy—a condition where the spinal cord becomes compressed—sometimes called spinal cord compression. People with myelopathy will experience a wide range of symptoms, although those symptoms may seem vague early on.

Symptoms of cervical spondylotic myelopathy might include:

Treatment of CSS will depend on the severity of your symptoms. Your treatment options include medications, physical therapy, complementary alternative medicine (CAM) therapies, and surgery.

Your healthcare provider can prescribe medicines to treat the symptoms of cervical spinal stenosis.

Medicinal options include:

Physical therapy (PT) can strengthen the back and neck muscles and stabilize the neck, reducing pain caused by cervical spinal stenosis. It might also help maintain the spine's flexibility and stability and improve balance.

While physical therapy can help manage pain, it is not a long-term treatment for spinal stenosis. This means you will need to get PT along with other treatments and exercise and continue to stretch the neck and back after other treatments have been completed to keep symptoms from coming back.

CAM therapies are used as alternative treatments and in addition to traditional therapies. CAM therapies that might help manage CSS include chiropractic medicine, acupuncture, and massage, as follows:

Healthcare providers will first offer nonsurgical management as a first treatment strategy for most people with progressive cervical stenosis. Surgery might be considered for people with severe symptoms, quality-of-life struggles, and neurologically difficult presentations. The goal of surgery would be to create space in the spinal canal and reduce pain and pressure.

Surgeries used to treat CSS include:

All surgeries come with risks, especially surgery on the spine near the spinal cord. Even so, spine surgery today is safer than ever, and results tend to be positive.

Postoperative risks associated with spine surgery include:

After surgery, you may need to wear a neck brace to stabilize the spine while you heal. You will likely stay in the hospital for a day or two for observation. In a few days, you will start physical therapy to help you adjust to the surgically treated bones. It might also help rebuild muscle in and around the affected part of the spine.

How quickly you recover will depend on different factors, such as your age, overall health, the type of procedure, and whether you had nerve damage from cervical stenosis.

You will have follow-ups with your healthcare provider a week or two after the surgery, then every six weeks until the bones have healed. This timeline might vary based on your surgery, health situation, and your healthcare provider's practice. Your healthcare provider will rely on imaging to monitor your healing.

In addition to the treatments offered by your healthcare provider or physical therapist, you can do some things at home to manage symptoms of CSS and keep the condition from worsening.

Self-care techniques to manage CSS include:

Cervical spinal stenosis is a treatable condition, but it cannot be cured, and its effects cannot be reversed. Even following surgery and spine stabilization, it is still possible to experience pain and other cervical spine symptoms. Fortunately, CSS responds well to both nonsurgical and surgical treatments.

To avoid disability and manage symptoms of CSS, you will want to do everything you can to keep your back as healthy as possible. This includes keeping a good posture, exercising and stretching regularly, maintaining a healthy weight, and following up with your healthcare provider, especially if symptoms return or worsen.

Cervical spinal stenosis (CSS) is a condition in which the spinal canal of the neck becomes narrow and presses on the spinal cord, producing pain and other symptoms that affect the neck, shoulders, arms, and spinal cord. CSS can sometimes be a progressive condition where inflammation of the spine leads to nerve damage.

CSS is a treatable and manageable condition. Treatments can help you feel better and include pain relief and anti-inflammatory medications, physical therapy, chiropractic care, and injections. Surgery is considered for people with severe pain and difficulties related to quality of life.

Self-care with CSS is vital and includes being active, avoiding activities that increase symptoms, and practicing good posture. You will want to follow up with your healthcare provider if symptoms return or worsen to avoid disability and disease complications like cervical spondylotic myelopathy.

Johns Hopkins Medicine. Lumbar spinal stenosis.

Goodwin AM, Hsu WK. Congenital cervical stenosis: a review of the current literature. Curr Rev Musculoskelet Med. 2023;10.1007/s12178-023-09857-9. doi:10.1007/s12178-023-09857-9

Smid CJ, Legare JM, Modaff P, Pauli RM. Apparently benign craniocervical signs in achondroplasia: "neurologic leftovers" identified through a retrospective dataset. Orphanet J Rare Dis. 2020;15(1):301. doi:10.1186/s13023-020-01584-5

Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. Handb Clin Neurol. 2014;119:541-549. doi:10.1016/B978-0-7020-4086-3.00035-7

Johns Hopkins Medicine. Lumbar disk disease (herniated disk).

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Spinal stenosis.

Balioğlu MB, Albayrak A, Atıcı Y, et al. Scoliosis-associated cervical spine pathologies. Spine Deform. 2014;2(2):131-142. doi:10.1016/j.jspd.2013.11.001

Ghobrial GM, Oppenlander ME, Maulucci CM, et al. Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review. Clin Neurol Neurosurg. 2014;124:114-118. doi:10.1016/j.clineuro.2014.06.012

University of Virginia. Cervical stenosis.

American Academy of Physical Medicine and Rehabilitation. Cervical stenosis.

Nell C, Bülow R, Hosten N, Schmidt CO, Hegenscheid K. Reference values for the cervical spinal canal and the vertebral bodies by MRI in a general population. PLoS One. 2019;14(9):e0222682. doi:10.1371/journal.pone.0222682

American Academy of Orthopaedic Surgeons. Cervical spondylotic myelopathy (spinal cord compression).

NYU Langone Health. Nonsurgical treatment for spinal stenosis.

Clijsters M, Fronzoni F, Jenkins H. Chiropractic treatment approaches for spinal musculoskeletal conditions: a cross-sectional survey. Chiropr Man Therap. 2014;22(1):33. doi:10.1186/s12998-014-0033-8

National Center for Complementary and Integrative Health. Spinal manipulation: what you need to know.

Clark A, Lucke-Wold BP. Acupuncture and spinal stenosis: Considerations for treatment. Futur Integr Med. 2022;1(1):23-31. doi:10.14218/fim.2022.00010

Institute for Integrative Healthcare. Four alternative therapies for spinal stenosis.

NYU Langone Health. Surgery for spinal stenosis.

University of Maryland Medical Center. Complications of spine surgery.

Smythe A, Jivanjee M. The straight and narrow of posture: current clinical concepts. Aust J Gen Pract. 2021;50(11):807-810. doi:10.31128/ajgp-07-21-6083

By Lana BarhumLana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.